Embracing Life’s Simple 7 slashes PAD risk

Key clinical point: The Life’s Simple 7 public health program points the way to reduced risk of PAD.

Major finding: Being in the top tertile of cardiovascular health by the American Heart Association’s Life’s Simple 7 metric is associated with an 86% lower risk of developing PAD than for those in poor cardiovascular health.

This is new evidence-supported information. Until this new analysis from the landmark ARIC (Atherosclerosis Risk in Communities) study, the relationship between Life’s Simple 7 and peripheral arterial disease (PAD) hadn’t been studied. It’s a relationship worthy of examination, considering that more than 8 million Americans have PAD, and nearly 40% of them don’t have concomitant coronary or cerebrovascular disease, which raised the question of whether Life’s Simple 7 applied to PAD risk, noted Dr. Garg of the University of Southern California, Los Angeles.

Bruce Jancin/Frontline Medical News

Dr. Parveen Garg

The new findings further reinforce the appropriateness of efforts to encourage the public’s adoption of the Life’s Simple 7 program, not only as a means of preventing coronary heart disease (CHD) and stroke – associations that are well established and were the foundation on which the program was established – but also for prevention of PAD. When the AHA originally developed the Life’s Simple 7 concept to support the organizational goal of substantial reduction of the burden of cardiovascular disease by the year 2020, the targets were CHD and stroke. The scope of the program was later broadened to include all cardiovascular disease, including PAD.

ARIC is a National Heart, Lung, and Blood Institute–sponsored prospective study of nearly 16,000 black or white individuals who were middle-aged at enrollment and have been followed for more than 2 decades. Dr. Garg’s analysis focused on 12,865 participants who were free of CHD, heart failure, prior stroke, and PAD at baseline, and have been followed for a median of 24 years.

As background, the metrics for Life’s Simple 7 consist of total cholesterol, blood pressure, blood glucose, smoking status, body mass index, physical activity, and adherence to a healthy diet score. Each element can be scored 2 points for ideal, 1 for intermediate, and 0 for poor. The composite Life’s Simple 7 score is rated optimal at 10-14 points, average at 5-9, and inadequate at 0-4.

During follow-up, 3.4% of ARIC participants developed PAD sufficiently severe to involve hospitalization. The incidence rate was 5.2 cases per 1,000 person-years for the 1,008 subjects categorized as having an inadequate Life’s Simple 7 score, 1.1/1,000 person-years for the 8,395 people in the average category, and just 0.4 cases/1,000 person-years for the 3,462 individuals in the optimal Life’s Simple 7 group.

Compared with subjects in the inadequate category, those in the average group were 56% less likely to develop PAD. Those in the optimal Life’s Simple 7 category had an 86% reduction in risk.

For each of the seven components of Life’s Simple 7 a person scored ideally in, the risk of incident PAD was reduced by 28% in a multivariate analysis fully adjusted for demographics, alcohol consumption, aspirin use, study site, left ventricular hypertrophy, and other potential confounders.

The inverse relationship between Life’s Simple 7 score and PAD risk was stronger in women than men. However, the association didn’t differ by race.

Dr. Garg noted that his study undoubtedly underestimates the true incidence of PAD in the ARIC population, since a hospital diagnosis was required. Also, to date he and his coinvestigators have only analyzed the results in terms of baseline Life’s Simple 7 score. It would be useful to also document the impact of change in the score over time.

Session moderator David C. Goff Jr., MD, observed, “This is very consistent with evidence in CHD that people who are in ideal cardiovascular health status have about an 80%-90% lower risk of cardiovascular mortality and a 70%-80% reduction in risk of total mortality compared with people who are in poor cardiovascular health status.”

“This study really does provide additional evidence that if we could get more people into the ideal cardiovascular health range, we’d probably see less atherosclerotic cardiovascular disease in general,” added Dr. Goff, who is director of the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute.